1043374093 NPI number — LINDA SLENTZ WISHKOSKI SLP

Table of content: DR. KEVIN M DUKES MD (NPI 1710955901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043374093 NPI number — LINDA SLENTZ WISHKOSKI SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WISHKOSKI
Provider First Name:
LINDA
Provider Middle Name:
SLENTZ
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SLENTZ
Provider Other First Name:
LINDA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043374093
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1205 NW 122ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98177-4328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16030 BOTHELL EVERRETT HWY
Provider Second Line Business Practice Location Address:
STE 140
Provider Business Practice Location Address City Name:
MILL CREEK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98012-1273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-338-9005
Provider Business Practice Location Address Fax Number:
425-337-0931
Provider Enumeration Date:
12/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  LL00001554 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8339038 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: R25667 . This is a "REGENCE PIN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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